Healthcare Provider Details

I. General information

NPI: 1720169774
Provider Name (Legal Business Name): MONICA JANETTE ROBINSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA BROADNAX

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JACKSON ST
FREDERICKSBURG VA
22401-5719
US

IV. Provider business mailing address

741 KENILWORTH AVENUE SUITE 100
CHARLOTTE NC
28204-3874
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-3223
  • Fax: 540-371-3753
Mailing address:
  • Phone: 704-523-8027
  • Fax: 704-523-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7457
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202009158
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: